Organization
EAGLES NEST GROUP HOME, DBA
Active
Other names
Eagles Nest Boys Residential Agency
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TED D MCCLURE I 6025681441 (EXECUTIVE-DIRECTOR)
(602) 568-1441
Entity
Organization
Contact information
Practice address
1802 E DOBBINS RD, PHOENIX, AZ 85042-8500
(602) 568-1441
(602) 268-4834
Mailing address
1802 E DOBBINS RD, PHOENIX, AZ 85042-8500
(602) 568-1441
(602) 268-4834
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
BH4442
DC
Other
Enumeration date
03/25/2014
Last updated
03/25/2014
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